Every summer, thousands of mental health professionals pack their bags and set off for the tiny town (Pop. 2,750).

Share via e-mail

IT’S HARD TO SAY which was the biggest clue about the character of our group grabbing lunch at Stewart’s Seafood Restaurant on the main drag in Eastham. The young waitress may have been onto us the moment gray-haired Linda informed her that our party of nine would require eight separate checks. Or maybe she overheard Carolyn with the funky eyeglasses talking about the production of Freud’s Last Session being staged at the Cape Playhouse. Or perhaps it was when Nancy, a bubbly retiree with braces on her teeth, ordered the roasted beet salad and a glass of water, and then, like some power-of-suggestion experiment, three other people in the group ordered the exact same thing.

In retrospect, I think the big tell may have happened just as we arrived at the restaurant. As I walked in with our group’s co-leader, Patricia Gerbarg, we found Nancy already there. She relayed word from the hostess that we could choose to sit either indoors or out on the patio. Dr. Gerbarg, a petite psychiatrist, turned to Nancy and, in a tone that would command an analysand’s attention, asked, “How do you feel about that?”

It’s summer on the Outer Cape, and that means the shrinks have once again returned. Each year, between Memorial Day and Labor Day, thousands of psychiatrists, psychologists, and other species of mental health professional bypass the bustle of the Mid-Cape to get to the comparative quiet of Wellfleet and its surrounding towns. It’s a natural phenomenon as reliable as the swells rising off Coast Guard Beach.

The therapists come here for various reasons, but a big one is that so many people in their line of work have come here before — going back three generations. The group I’ve joined on this day in late June evokes the summer excursions that Sigmund Freud himself took to Bavaria and the Swiss Alps a century ago, vacationing with his eager psychoanalyst students, who in turn were trailed by some of their patients.

But instead of Freud and his followers, at this sticky picnic table we have Gerbarg and her husband, Dick Brown, leading students in a lunchtime discussion. Although both are practicing psychiatrists and Gerbarg trained as a psychoanalyst, their approach these days is a world apart from the traditional five-times-a-week, tell-me-again-about-your-childhood therapy sessions from Woody Allen movies. In that way, the couple reflect the profound changes in the wider mental health world brought about by everything from insurance reimbursements to advances in brain science, crosscurrents that can be acutely detected during summer on the Outer Cape.

While some locals shrug off talk of this curious migration of mental health professionals, others are fascinated by how the flock affects their stretch of rugged coastline, and how the region in turn affects the flock. Sky Freyss-Cole, a 28-year-old Wellfleet native born to hippie parents and raised in a yurt — her full first name is November Sky — tells me she never fully appreciated her eclectic town’s reach until she moved to Copenhagen several years back. There, the consultant met bright lights in the field who knew all about her tiny hometown (year-round population: 2,750). “I had to move to Denmark,” she says, “to learn how big a place Wellfleet was on the international therapist map.”

GIL LEVIN WALKS THE OPEN CAMPUS of Nauset Regional High School, a series of ’70s-style buildings with weathered siding in Eastham, just up the road from Nauset Light Beach. He has a white beard, round glasses, and a round stomach on which he tends to rest his folded hands whenever he is sitting. He is 79 and calls to mind the Richard Attenborough character from Jurassic Park. Like him, Levin strolls slowly and with evident satisfaction with his remarkable creation. In Levin’s case, that creation is the Cape Cod Institute, a series of professional workshops he has run for 34 years.

“Masters and Johnson came here to speak,” he says, “before and after they were divorced.”

And Levin wasn’t even the earliest therapist to draw a crowd to this area. The first beachhead appears to have been established by Clara Thompson, a New York psychoanalyst who became a summer fixture in Provincetown in the 1940s. In the Freudian tradition, a coterie of Thompson’s disciples followed her on vacation, mixing easily with P-town’s avant-garde community of artists and poets, gay and straight. Eventually, the shrink summer population radiated to Truro, Eastham, and especially Wellfleet.

In the 1970s, husband and wife Edwin and Sonia Nevis arrived from Cleveland and began holding workshops in a series of Outer Cape motels. Over time, they developed an optimism-focused therapeutic approach they called “the Cape Cod Model,” and their tourist operation became a year-round enterprise, the Gestalt International Study Center in Wellfleet. In the 1980s, the Boston Graduate School of Psychoanalysis began heading to the Cape for its annual summer conference, something it will do again in August when it sets up camp in the Wellfleet Elementary School.

Julia Cumes For the Boston Globe

Gil Levin, founder of the Cape Cod Institute, has perhaps done more to cement the bond between therapists and the Outer Cape than anyone. Pictured, Levin (left) mingles at his institute.

Although Levin wasn’t the first, it’s hard to think of anyone who has done more to cement the bond between therapists and this area. The clinical psychologist started the Cape Cod Institute in 1980, when he was on the faculty of the Albert Einstein College of Medicine in the Bronx. Since its inception, the series of weeklong seminars has offered psychotherapists and others the chance to get the continuing-education credits they generally need to maintain their licenses while also enjoying a relaxing, tax-deductible vacation. He devised the formula early on and has stuck with it. He lines up notable speakers from psychology, psychiatry, and organizational behavior, who each teach five weekday sessions, from 9 a.m. to 12:15 p.m. After that, participants get the rest of the day to swim in the ocean, cycle the bike trail, or doze off in the dunes.

Levin seems to grasp that the enduring power of the Cape springs in large part from the rhythm of familiarity. That’s why people tend to go to the same places, year after year, for ice cream or fried clams — often regardless of quality — rather than seeking out new ones. At the Cape Cod Institute, they’ve been serving the same kind of egg salad at the morning break for as long as anyone can remember, and people still look forward to it. (“The secret,” Levin confides, “is industrial-strength mayonnaise.”)

As much as Levin has leveraged the familiar, he and his assistant director, social worker Molly Eldridge, have worked to adapt to changes in the field. Traditional psychoanalysts were there at Levin’s first summer session, which was called “Therapies for the ’80s.” But the speakers whose classes I attended during my stint at this year’s institute were decidedly nontraditional. One, a social worker, specializes in something called Accelerated Experiential Dynamic Psychotherapy, or AEDP, which engages the therapist as an active participant in the process. And the husband-and-wife psychiatrist pair of Pat Gerbarg and Dick Brown have replaced the analyst’s couch with, among other things, intense breathing exercises.

At one point, the Harvard-trained Gerbarg described her own harrowing ordeal when what turned out to be neuro-Lyme disease went undiagnosed by conventional medicine. “I was an invalid,’’ she told me when I joined some of her students in the lunch discussion group. She went so far as to begin seeing her patients while she was the one lying down on a couch, instead of them.

Antibiotics helped, but she credits more of her complete recovery to the alternative medicine and advanced breathing techniques championed by her more alternative-geared husband, a longtime associate clinical professor at Columbia.

As the AEDP workshop breaks for egg salad, an assistant reminds the participants that they have to sign out on a clipboard near the back of the room. There is a good deal of grousing from the group of mostly middle-aged professionals. Clearly, they resent being treated like the high school students who use this music room during the rest of the year. But those are the rules if they want to end the week with their full 15 continuing-education credits for 15 hours of classroom time.

And the grousing tends to fade fast. The seminars, after all, remain very popular, drawing attendees from around the world. While I was there, I met a psychiatrist from Panama, and this summer has seen participants from Japan, Ukraine, and the island nation of Mauritius, though the typical profile is of an American psychologist or social worker from the Northeast. Many participants come every year, making a summer tradition of it.

Levin’s approach has been a winner — both critically and financially — from the start. And that didn’t go unnoticed. In 1984, four years after he started his operation, Levin came across a brochure for a new seminar series. The brochure was the same size, and similar in design, to his. Whereas his operation was called the Cape Cod Institute, this one was called the Cape Cod Summer Symposia of the New England Educational Institute. Like his, this brochure was mailed around the country and advertised big names who would lecture on weekday mornings from 9 to 12:15, giving attendees the rest of the day off. The operation was even to be held in the Sheraton in Eastham, the same hotel where Levin had once housed his institute.

Levin was incensed, seeing this not as friendly competition but rather as a cynical attempt to confuse people into attending a facsimile of his institute. His employer, Albert Einstein med school, filed a trademark infringement suit in federal court against the new competitor, Boston University-trained psychiatrist Robert Guerette.

Two years later, a jury rejected the claim by Levin and his medical school. In the three decades since the heat of that six-day trial, a cold war has simmered between Levin and Guerette and their respective operations. Levin tells me he doesn’t like to talk about it, but when he does, he airs old grievances as if he’s stinging from a fresh cut. As we sit in the cafeteria, a representative of a whale watch company sits at a table nearby, selling participants tickets for an upcoming excursion. Levin complains that Guerette still tries to confuse people, often going so far as to schedule his group whale watch on the same night as Levin’s.

IT’S A SUNNY, BREEZY EVENING as I hurry up the Provincetown pier to board the Dolphin IX. Levin’s staff had told me that some Cape Cod Institute attendees would be passengers on this whale watch, though none of the ones I’d already met, so I had planned to arrive early to find them.

As it turned out, I made it to the pier just minutes before the boat got underway. In the distance, the East End waterfront house where psychoanalyst Clara Thompson had lived during the 1940s and ’50s still stands. I was late getting onboard because I’d been moored in a different place in the past. Earlier that afternoon, I had made my way to the home of Robert Jay Lifton, a man who may well constitute the oldest living tie to the history between psychiatry and Wellfleet.

Lifton lives in a rustic house on a cliff overlooking the beach in his secluded multi-acre swath of the Cape Cod National Seashore park. I met him in his book-lined study, with his white standard poodle Jingly lying at his socks-and-sandals-covered feet. The psychiatrist has big glasses and a head of shoulder-length white hair that is unusually full for an 88-year-old. As leaves rustled outside his study door, he told me, “Once you come here, the place gets a hold on you.”

Neil Swidey

During meetings at his Wellfleet home, psychiatrist Robert Jay Lifton co-created the academic discipline called psychohistory.

In 1966, the same year Lifton and his wife moved into their Wellfleet place, he and his mentor, the noted psychoanalyst and development expert Erik Erikson, hosted a meeting of psychologists, psychiatrists, sociologists, and historians here in Lifton’s study. The convening of this Wellfleet Group became an annual tradition. And, in this perch overlooking the Atlantic, they hatched the academic discipline of psychohistory, which explores history through the lens of psychology and psychoanalysis. Lifton had blended these fields in his own pioneering research into everything from Chinese thought reform to nuclear disarmament, and issues of war and peace have generally dominated his group’s discussions.

In the fall, he will once again host his annual meeting, nearly a half century after the first one. “There’s something about the ocean and the dunes that lends our discussions a cosmic dimension,” he explained. Even for non-psych types, all this deep thinking seeps into the area, giving Wellfleet what Lifton calls “intellectual ambience.” It’s not enough that this tiny town supports two bookstores, but even the small grocery store on Main Street devotes a full aisle to quality books. Instead of mini-golf, the go-to evening entertainment is a lecture series at the Wellfleet Public Library. As librarian Elaine McIlroy told me, “Around here, serious sells.”

By the time I make it onboard for the whale watch, though, I have to set aside the past for the present and try to find some of the students from Levin’s institute. When the Dolphin IX starts to rock dramatically from the suddenly rough seas, I spot a middle-aged woman sitting in front of me, desperately trying to steady herself. I decide to take a chance. “Are you from the Cape Cod Institute?” I ask.

“Yes,” she nods. “Are you?”

Her name is Joanne Thomas, and she’s a clinical social worker from Binghamton, New York. She says the ocean swells were giving her the chance to employ the meditation tips she’d been learning at the institute. “Even if we’re about to tip over,” she smiles, “I’ll remain calm!”

I ask her which class she is in. She says the one being taught by Siegel, a name I don’t recognize from all the time I spent at the high school in Eastham with Levin. Then it dawns on me what may be going on.

“Are you at the institute being held at the high school or at the Sheraton?” I ask.

“The Sheraton,” she replies, clutching the seat back in front of her. “Are there two of them?”

Later in the whale watch, I bump into a group of three from Dayton, Ohio. “Any chance you’re from the Cape Cod Institute?”

“Yes,” says one of them, a psychologist named Nancy Milam. Just then, the boat PA system crackles with the voice of the tour guide, announcing the spotting of a humpback that is “fluking,” prompting a flood of camera-clutching passengers to race to the other side of the boat.

“Which session?” I ask Milam, trying not to get trampled.

“Mindfulness Meditation, with Siegel.”

Suddenly I hear the outraged voice of Gil Levin resounding in my head.

LEVIN’S NEMESIS WALKS AS QUICKLY AS HE TALKS. Actually, as he moves through the halls of the Four Points by Sheraton in Eastham, Rob Guerette doesn’t so much walk as glide. Leveraging his French Canadian heritage, he chats briefly in French with a Canadian attendee, pats the back of another, and then summons an assistant to relay from his tiny notebook all the matters that need attention.

Guerette, who is slim and sports a gray goatee, departs from the “Cape casual” dress everyone else seems to follow at the Cape Cod Symposia he’s been running for 30 years. Instead, he wears a jacket and tie. At one point, as I try to keep up with his movements, he stops abruptly and says, “If you had to pick one word to describe me” — something I hadn’t asked him to do — “it would be impresario.”

Guerette freely admits that he got the idea to build a therapist continuing-education program on the Cape from Levin. But he says the initial idea to enter the therapist education business actually came from somebody else.

Joanne Rathe/Globe staff

Rob Guerette’s program, the Cape Cod Symposia of the New England Educational Institute, is a longtime rival of Levin’s institute.

In 1981, Guerette, then a practicing psychiatrist, attended a weekend training seminar at the Sugarbush ski resort in Vermont. He sat in class for a couple of hours in the morning, hit the slopes, and then returned to class for another couple of hours in the evening. He enjoyed himself so much that he started a competing seminar the following year — at Killington.

Years later, when Guerette ran into the organizer of that original Sugarbush seminar, the man testily told him, “I almost sued you.” Guerette, though, didn’t think he had done anything wrong. He felt he’d simply taken someone else’s idea, put his own twist on it, and built a successful business. And once he came to the Cape, he found a whole new level of success.

Although he beat Levin in court, Guerette says it cost him about $140,000 in legal fees. (A native of Beverly, he maintains his North Shore accent, rendering the number 40 as “faughty.”) Yet within a few years he had recouped those losses, and his Cape program was pulling in more therapists than Levin’s.

Guerette built his program with an obsessive attention to detail. Two of his two daughters used to work for him, though one ended up quitting, telling him, “Dad, I love you as a father, but I hate you as a boss.” He also employed some brass-knuckled tactics. If Levin had speakers who drew big crowds, Guerette would poach them for his program the following summer. He’d offer them bigger paychecks and other perks, like providing showplace beachfront homes for them and their families to use during their stay. “Whatever it takes,” Guerette says. His philosophy: “They’re shrinks, but they’re still human beings.”

Levin, who took over ownership of his program after he retired from teaching, pays his speakers the same rate no matter how many people sign up for their lecture. But Guerette often offers more money to the speakers who fill the most seats — incentivizing extra hustle on their part.

I try to keep up with Guerette as he walks through the heated swimming pool area of the Sheraton to get to a ballroom in the back. There, he introduces me to one of his notable repeat speakers, psychologist Ron Siegel, a Harvard Medical School assistant professor who’s been leading about a hundred students through morning sessions all week. He’s the man behind the Mindfulness Meditation class I’d heard so much about on the whale watch.

After a brief chat, Siegel, a pleasant guy with an elaborate mustache and his hair parted in the middle, excuses himself to use the men’s room. A few minutes later, he returns and begins his class. “Maybe this is oversharing,” he tells the crowd, “but I just had a moment in the bathroom where I thought, ‘Wow, I’m here in the bathroom.’ ” That, he says, is real awareness. Achieving it can be the difference between spending a week walking the beautiful beaches of Cape Cod while still trapped in regular-world worries or one where you’re truly able to notice “the waves and the sand.”

Siegel leads the crowd through an exercise that he warns will be intense, telling his students to find some anxiety inside them and refuse to let it go. When he says things like “It’s my old friend fear. I know you!” he sometimes comes across like a Christopher Guest character.

After he rings his bell to end the exercise, a woman with a thick Eastern European accent takes the microphone and says: “I couldn’t hold on to it. Can you explain why the anxiety disappears when you have to have it?”

The question draws big, knowing laughs from the crowd. Siegel smiles and then apologizes for answering this question for a female-dominated crowd using a male-focused simile. “The mind is like a penis,” he says. “Anything you try to do, it will do the opposite.” Then he offers a couple of examples. “You’re in the junior high locker room, and the one thing you don’t want is an erection?” Pause. “Well.” Pause. “You’re on an important date, and the one thing you want is an erection?” Pause. “Well.”

Siegel moves on to his own personal medical story. He once suffered a herniated disk that caused back pain so immobilizing that he was forced to meet with patients while he was lying down, rather than the other way around. He went to a series of conventional doctors who recommended surgery yet admitted his chances for full recovery were small.

But mindfulness meditation and vigorous exercise got Siegel his life back. He tells the crowd what he found from years of research: Back pain is directly correlated with stress, and that people’s low job satisfaction is a much bigger predictor of it than whether they sit hunched over a computer at work.

Siegel’s story — of a highly credentialed medical professional being radicalized after mainstream medicine failed him — brought flashbacks from Levin’s institute and Gerbarg’s discussion of her Lyme disease.

During the morning break in Siegel’s talk — hummus instead of egg salad — I spot Joanne Thomas, the social worker I’d met on the whale watch. She tells me she’s been enjoying his class all week. “He offers an optional meditation session until 2 o’clock, but I left at 12:15,” she says. “We’re on the Cape, after all. I needed the beach!”

THE SUMMERING PSYCHOTHERAPIST has traditionally been an easy-to-spot species both on and off the beach. When Gwynne Guzzeau, who grew up on the Cape, spent her college breaks waitressing at the Lobster Pool in Eastham to help pay her way through Wellesley, she found there were two reliable ways to identify her shrink customers. First, the men usually sported the profession’s stereotypical beards and glasses. Second, they would never simply ask what her college major was. They would follow it with open-ended questions like “And what do you hope to do with that?”

Guzzeau admits these questions could be annoying, especially on busy nights. But she thought differently after years of working as a lawyer at a big firm in Washington, D.C., and then following her heart home to the Cape. Today, she serves as executive director of the Gestalt International Study Center.

Dina Rudick/Globe staff

Participants in a workshop at the Gestalt International Study Center in Wellfleet.

That permanent outpost, whose founders had begun their Cape operation roaming from motel to motel, sits in an airy building just off Route 6, across from a cemetery.

Although the center still relies on its Cape Cod Model, which seeks to address people’s problems by starting with what they do well, it has had to adapt to the times in other ways. While the Gestalt center initially focused on training therapists, it is increasingly drawing life and executive coaches. This fast-growing field of self-improvement professionals doesn’t carry the baggage of traditional psychotherapy. A CEO who would never admit to needing therapy or asking his company to pay for it wouldn’t think twice about getting company-underwritten training from a mentor-like executive coach. Meanwhile, insurance companies have continued the squeeze on traditional therapists by repeatedly reducing their reimbursement rates. Around the Gestalt center, there’s a new running joke: “What’s the difference between a coach and a therapist? About $250 an hour.”

These market forces have also affected the dueling institutes. At its height in the 1990s, Levin’s Cape Cod Institute attracted more than 1,300 students a summer. That figure will be closer to 1,100 this year, a modest dip Levin attributes to the fact that professionals can now get their continuing-ed credits through online classes, with tuition that’s considerably less than what he charges, $599 for each weekly course (not including lodging). But he remains confident that the market for the experience he’s offering will remain robust. “Even though the ballgame is on TV,” he says, “there will always be people who want to go to Fenway Park to watch it.”

Across town, Guerette’s Cape Cod Symposia is roughly the same size as Levin’s, though it once drew nearly twice as many attendees. To attract customers, both have added speakers addressing the latest trends in mental health, such as brain science advances. Yet Guerette has had to scale back his summer schedule, from 10 weeks to seven, and now runs two five-day classes a week rather than three.

Dina Rudick/Globe Staff

Gwynne Guzzeau, executive director of the Gestalt center, which is increasingly training life coaches.

Guerette has seen the industrywide changes reflected in his bottom line, too, including the rise in cheap or even free online courses, the reduction in employer travel reimbursements, and the way that Freudian psychoanalysts who see patients four and five times a week are a dying breed outside of big cities. (One of the sessions at this August’s Boston psychoanalysis conference in the Wellfleet Elementary School will be entitled, rather defensively, “Why the Need to Declare Psychoanalysis Dead?”) Because insurance companies won’t pay for that kind of treatment, Guerette says, most psychiatrists focus on what they do get reimbursed for: pharmacology, or doing medication checks. A lot of the “talk” therapy has fallen to social workers, whose reimbursement rates are low enough for insurance companies to cover them.

Still, he agrees with Levin that there will always be a healthy supply of customers for their kind of continuing education. In fact, he offers a familiar metaphor. “There will always be people,” he says, “who want to go to Fenway to see Dustin Pedroia play.”

Nevertheless, after three decades of battling Levin from their separate corners of town, Guerette says enough is enough. “I’m going to be 65 soon,” he says, “and Gil is even older than I am.” It’s time to let things go — or maybe even collaborate, which could be good for business. But Guerette says Levin has rebuffed the modest peace overtures he’s made in the past. Offhandedly, he asks me if I can try to broker a summit between him and the other titan of summer shrinktown.

SIX SUMMERS AGO, Guerette slipped onto the campus of Nauset Regional High School for some espionage, although he prefers to call this practice “corporate benchmarking.” Both sides say that over the years they’ve spotted spies from the other camp trying to infiltrate their seminars. On this occasion, Guerette did it himself rather than dispatch a proxy. He planted himself on a bench on Levin’s turf, with his only disguise being an open newspaper in front of his face. Eventually, Levin came over and sat beside him.

“He asked me where I got the newspaper. He didn’t even notice that it was me,” Guerette recalls, shaking his head. “He’s such a narcissist.”

Later, I make my way back to the Cape Cod Institute’s high school campus. As soon as I arrive, Levin greets me with a smile. But when I mention the olive branch I’m carrying from Guerette and ask if he’ll join us both for lunch, the smile tightens.

“If that happens, it will be between me and him,” Levin says.

“So you’re not interested in sitting down with him?” I ask.

“I didn’t say that,” he says chidingly. “I said it’s not of your concern. And I don’t wish to say any more about this subject.”

Gingerly, I try to explain that since he’s rebuffed the previous peace overtures, it sounds as though he’s adopting the same stance.

Levin changes the subject. But for some reason he ends up talking about one of his favorite speakers from years past and how that man used to say, “Anything worth doing is worth overdoing.”

I’m not sure how to take that. It’s tough playing psychological games with a master psychologist. I explain that even though he’s telling me to drop the summit idea, the message he seems to be giving me by quoting his late friend’s aphorism is that I should keep pressing it.

“Yes, I guess that would suggest that you should persist,” he says, chuckling. But he repeats that he doesn’t want to discuss the matter any further.

I remember Guerette’s parting words, when he warned me not to get my hopes up in trying to play peacemaker between him and Levin. “He can’t let it go,” Guerette had said. “He needs some therapy, man.”

Given their long feud, maybe the two men should sit down together for a few sessions with a couples therapist. They both know where to find a good one.